The Financial Supervisory Service said on the 6th that when an accident such as death or a disability with aftereffects occurs due to medically negligent treatment that is objectively proven, such as a settlement between the hospital and the patient, it may fall under an accidental injury as defined in the insurance policy. Not only medical negligence caused by procedures such as surgery by medical staff but also medical negligence by omission, such as missing the treatment window due to a misdiagnosis, can fall under an accidental injury.
The Financial Supervisory Service (FSS) on the 6th provided consumer guidance, saying, "With respect to third-sector insurance that deals with disease and injury, disputes continue to arise in which insurers refuse to pay accident insurance benefits on the grounds of medical negligence, or cancel contracts for breach of the duty of disclosure and refuse to pay benefits."
The Financial Supervisory Service (FSS) said, "Even if an insurance subscriber (the insured) consented to surgery, that cannot be seen as consenting to the result of being injured due to medical negligence," and explained, "Medical negligence is not a preexisting disease but an accidental and fortuitous event from outside, and thus constitutes an injury as defined in the policy."
Regarding cases where the treatment window is missed due to a misdiagnosis, it said, "The externality requirement for an injury means it is caused by an external factor," and added, "If medical negligence by omission caused bodily harm, it cannot be viewed differently from medical negligence by commission, so externality is recognized."
The Financial Supervisory Service (FSS) guided that if it is confirmed that an agent obstructed disclosure, insurers cannot cancel the contract by applying a breach of the duty of disclosure or refuse to pay benefits. The Financial Supervisory Service (FSS) said, "If it is confirmed through a recorded call or a solicitation report, etc., that the agent did not give an opportunity to disclose or interfered with disclosing truthfully, a breach of the duty of disclosure cannot be applied."